# Combined Pericapsular Nerve Group (PENG) and Ilioinguinal-Iliohypogastric Blocks for Pediatric Pelvic Osteotomy: A Tailored Regional Anesthesia Approach

## TL;DR

This paper describes a combined nerve block technique for effective pain management in a high-risk pediatric patient undergoing pelvic surgery.

## Contribution

The novel contribution is combining PENG and ilioinguinal-iliohypogastric blocks for comprehensive analgesia in pediatric pelvic osteotomy.

## Key findings

- The combined nerve block provided stable intraoperative and postoperative analgesia.
- The approach eliminated the need for rescue opioids in a high-risk pediatric patient.
- The method offers a safe, tailored regional anesthesia strategy for pediatric pelvic surgery.

## Abstract

The pericapsular nerve group (PENG) block is a regional anesthesia technique that targets the articular branches innervating the anterior hip capsule, offering effective analgesia with minimal motor blockade. While its utility in hip surgery is established, its solitary use in pediatric pelvic osteotomies leaves the cutaneous incision site uncovered. We report the case of a 21-month-old male with significant cardiopulmonary comorbidities undergoing a unilateral pelvic osteotomy. To minimize respiratory and hemodynamic risks associated with opioids, a multimodal, opioid-sparing analgesic strategy was implemented. This approach combined an ultrasound-guided PENG block with an ipsilateral ilioinguinal-iliohypogastric nerve block to ensure comprehensive coverage of both deep articular and superficial somatic pain. The intraoperative course was stable, and the patient demonstrated excellent postoperative analgesia with no requirement for rescue opioids. This case highlights that supplementing the PENG block with an ilioinguinal-iliohypogastric block provides a tailored, anatomical solution for pediatric pelvic osteotomy, offering a safe and effective regional anesthesia strategy for high-risk pediatric patients.